83 



January 1847, remarks, that these paroxysmal fevers are disturb- 

 ances of the nervous system, periodicity being a peculiarity of 

 nervous disorders and unknown in inflammation. "The most striking 

 peculiarity of quinine," he says, "is its power to prevent the return of 

 periodical affections, and this appears to me to be effected by blunt- 

 ing the susceptibility of the nervous system." He does not give it 

 during the paroxysm, as this, "when once fully developed, will usually 

 run its course despite of any efforts we may use to check it." But the 

 exacerbation having subsided, "our treatment should be directed to 

 the prevention of its return, and my invariable rule is never to -permit 

 the recurrence of another paroxysm after I see the patient." This 

 he effects by giving from fifteen to twenty grains during the remis- 

 sion, sometimes as high as thirty or forty grains, never more. The 

 dose may be two grains hourly, or twenty grains at once, according 

 to the length of the paroxysm. Cephalic or other local symptoms 

 of congestion do not deter him from giving it; "the stronger the 

 tendency of the disease to localize itself, the more urgent the neces- 

 sity to arrest it." 



65. On the subject of periodicity, Dr. Graves remarks, that the 

 periodicity of intermittent fever does not apply to the succession of 

 paroxysms alone, but is extended to the free interval. He ascer- 

 tained that a quartan ague returned after various lengthened 

 periods, precisely at the day and hour on which the fit would have 

 been due, had the disease progressed uninterruptedly.* 



66. The next form of fever to which the Committee would now 

 advert, is puerperal fever. Its contagious nature and the connection 

 it has with erysipelas, have occupied the attention of numerous 

 writers, who have brought their opinions before the profession in 

 such interesting points of view, that it is not possible to pass them 

 by without notice. Dr. Kneeland has contributed to the American 

 Journal for January and April, 1846, articles so thoroughly cover- 

 ing the whole ground and so ably and elaborately sustaining all his 

 positions by argument and authority, that no apology is necessary 

 for offering a rapid sketch of his views. He shows that the disease 

 is carried from one diseased person to another, and that usually by 

 the accoucheur or nurse. A post-mortem examination of one dead 

 of the disease, will cause it to be propagated by the physician to the 



* Ranlnng's Retrospective Address. 



